H.Pylori is the deadliest thing you’ve never heard of — here’s why you should be screened for it

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Most people won’t know about Helicobacter Pylori (H.Pylori), a common bacterial infection of the lining of the stomach. Yet it affects around half of adults in the UK and virtually everyone by the age of seventy.

Unfortunately H. Pylori often causes no symptoms but is associated with a number of significant conditions such as stomach cancer. It is estimated that 2500 new cases of stomach cancer occurring within the UK each year are linked to the presence of H.Pylori infection.

Research from the University of Leeds published in the British Medical Journal last week demonstrated that screening for H.Pylori – perhaps as part of a full health check or health assessment – can reduce the risk of developing stomach cancer by one-third. The research team found that only 51 stomach cancers occurred among 3294 individuals tested and treated for H. Pylori compared to 74 out of 3203 control subjects who had not been screened

A simple stool sample or a blood sample can be used to test for H.Pylori. Moreover, if the infection is found the treatment is very straightforward involving one week of tablets taken by mouth. Most commonly the therapy consists of two types of antibiotics and something to reduce the amount of acid produced by the stomach cells.

Sadly stomach cancer survival rates remain low with less than one fifth of people living for five years or more after diagnosis. Around 4,800 people in the UK died from stomach cancer in 2011.

Health screening including H. Pylori testing in people with or without any symptoms in their abdomen (tummy) is a simple way to reduce the devastating impact of stomach cancer on individuals and their families. Even those who have been tested in the past should also consider having further health screening as 2% of H. Pylori infections can recur.

The point value for the relative risk of stomach cancer is those treated in comparison with those not treated with antibiotics was 0.66. But ,as this study only included a sample of the world`s population it can be further calculated that the true value for the relative risk will lie anywhere between 0.46 and 0.95 with 95% certainty. A relative risk of 1 means that there is no difference between groups but as the range of possibilities here is less than 1 (with 95% certainty) it can safely be argued that such a finding is statistically significant (at the generally accepted 5% level). Nick

Sinceyouask

I am retired now, but during my time in practice I came across Nick Summerton on several occasions, and can confirm that he his an excellent doctor, and a good clinical scientist. The expanded answer to Jon’s question demonstrates his ability to make the answers to complicated questions easier to understand.

However, even if we assume that the findings from this single study are correct, perhaps a better question would be “can we have confidence that the construction of a national screening program would deliver comparable benefits?” Screening seems such a good idea that it seems churlish, at the very least, to question its value. However screening programs for breast, cervical uterine and prostatic cancer have proved far from straightforward, and the balance of benefit between true and false positives and negatives are not quickly or easily established.

Screening cannot “reduce the risk of stomach cancer by one third”. It is treatment which would do that. Dr Summerton knows this, of course, and it’s probably just sloppy editing. But it is the equivalent of an enthusiast’s Freudian slip. The best case would be that screening may identify a group of apparently normal people who, if treated, may not go on to develop stomach cancer.

For every one of these there will also be some patients who will be falsely reassured they don’t have the disease (and who may then ignore symptoms and delay presentation), and some who will have to undergo treatment and investigation for a disease they don’t have.

These calculations of benefit are complicated. I don’t know enough to provide the answers, but I do know enough to say that caution is usually wise. An even more difficult question is whether the Spectator is an appropriate journal to publicise, still less recommend, an intervention which I infer to be of as yet unproven benefit to normal populations. Over to you Theodore Dalrymple…..

Nick Summerton

Thank you very much for your kind words and comments. I would not advocate a formal national screening programme for H pylori but rather an opportunistic `test and treat` screening strategy at this time. I think it is important that we are all aware of the research and be given the chance to ask for testing if we wish – either via the NHS or privately. Interestingly one of my patients presented me with a stool sample first thing this-morning having read this blog. I did also check that the donation was for H pylori testing. Nick

commenteer

I think most of us know about H.Pylori and the history of its discovery (doctors really must learn not to patronise reasonably intelligent people). However, thank you for alerting us to the existence of a simple blood test.

John Lea

learn some manners you pompous ar*ehole.

Stephen Spawls

Jus a short technical point. It should be Helicobacter pylori. The specific name of a living organism always begins with a lower case letter.

SackTheJuggler

I’ve heard of it. Helicobacter is such a cool word. “Colonel Zarg! I am placing our elite Helicobacter unit at your disposal. Do not fail me.”

Most people have it by age seventy? Who says? Good to know that they no longer take a day out of one’s life with a sedation and a scope to find out, though.

Mrs Josephine Hyde-Hartley

But Dame Sally Davies Chief Medical Officer for England, is currently raising concerns about the use of antibiotics generally. If somebody is not troubled by the flora and fauna of their own body, would administration of antibiotics because of risk be a proper use of taxpayer funded NHS? Or is it a private thing? Perhaps a quick course of these antibiotics could be made available to the general population and sold over the counter..just in case..